Quality Assurance Management

Kristine L. Hicks

**** **** ***** ( Little Elm, Texas 75068 ( Telephone: 214-***-**** (

Mobile: 214-***-****

Email: **********@*******.***

[pic]

VP/Director/Manager, Provider Services & Revenue Cycle Management

Streamlining Billing Operations . Performance Metrics . Multiple Program

Management . HIPAA/HFCA/JCAHO Compliance . Service Center Operations .

Business Process Re-Engineering . Managing Multiple Business Units

. Claims, Eligibility & Benefits Verification . EMR/EHR Integration .

Hospital/Physician Office Administration

VP/Director/Manager of Provider Services & Revenue Cycle Management with

more than 14 years of front and backend revenue cycle leadership in

converting legacy processes and systems to e-commerce service and payment

cycle solutions that drive healthcare revenues while decreasing operational

costs.

[pic]

Career Highlights

> Entrusted by CGI senior management with launching and managing all

aspects of the implementation and ongoing operations for HMO, Medicare

Part D programs with a contract value of more than $60 million.

Consequently, achieved the 'Network of the Year Award' for outstanding

performance and improving client relationships.

> Implemented the division's first quality assurance program for CGI that

focused on metric development, HIPAA compliance and performance

measurements that increased operational outcomes by 35% over a 6-month

period. Concurrently, managed premium billing and customer service to

more than 600,000 beneficiaries.

> Charged with directing business development, operations, and marketing

efforts for Advanced Logic Industries, throughout the U.S., Europe,

Mexico, and Asia while simultaneously rebuilding the infrastructure and

marketing materials throughout the organization. Subsequently, increased

earnings by 80% in the first 9 months of operations.

[pic]

Benefit Statement

Demonstrated 8-year track record of promotions from Business Unit Director

of Physician Practice Network Development/Administration, to Regional

Director of the Licensed Network Division for the Western U.S., to National

Director of Quality Assurance; and finally to Vice President Client

Services of the South Central Region.

[pic]

Key Areas of Expertise

Client Relationship Management (CRM) . P&L Management . Creating a Shared

Revenue Cycle Management Vision . Ability to Grasp and Utilize New

Technology . Instituting Cost Reduction Technologies . Instituting

Efficiency and Productivity Improvements . Integrating Multi-Tier E-

commerce Service and Payment Systems . Implementation of Quality Assurance

Programs

[pic]

Professional Experience & Accomplishments

Gerson Lehrman Group - Healthcare Council, U.S., Europe and 2008 to Present

Asia

(The world's largest global marketplace for intelligently connecting

institutions and expertise since 1988)

COUNCIL MEMBER - Range of duties may include participating in telephone

consultations, providing survey outcomes, developing reports, attending in-

person meetings and managing on-site projects for healthcare companies and

investment firms affecting healthcare services sectors.

CGI Inc., Ft. Worth, Texas (Left due to corporate downsizing)

2006 to 2007

(Ranked #1 solutions provider in the insurance industry in 2006, ISO 9001

Certified)

DIRECTOR OF HEALTHCARE, MEDICARE D PROGRAMS - Scope of duties consisted of

leading a large-scale operation including premium billing and customer

service centers to more than 600,000 beneficiaries. Additionally,

proficient in analyzing profitability of on-going payment programs while

simultaneously understanding, interpreting, and adhering to state, federal

and corporate guidelines.

> Orchestrated the installation of an e-health record storage and retrieval

system, which converted over 300,000 patient encounters from a manual

system within 2 months, while simultaneously implementing the associated

software for retrieval.

Kristine L. Hicks

Page Two

[pic]

> Dramatically reduced the total number of delinquent incomplete patient

encounters by 130,000 which proved instrumental in achieving corporate

goals for meeting regulatory compliance and legal requirements.

> Developed comprehensive quality assurance programs and revisions of

company policies and procedures, resulting in a total of 4 Annual

deficiency-free state and federal licensure surveys.

Advanced Logic Industries, Inc., Blacksburg, (Left due to relocation to Dallas,

Virginia Texas) 2004 to 2005

(First to market provider of Unified Messaging Integration between Novell

and Cisco Systems)

BUSINESS DEVELOPMENT EXECUTIVE - Primary duties focused on rebuilding

internal infrastructure and leading the development of the following

functions: establishing marketing collateral; website branding/PR

campaigns, developing sales strategies, and instituting policies/procedures

throughout the organization.

> Negotiated and produced in 9 months, more than $700,000 in revenue, based

on a $21.00 per seat cost model.

Matria Healthcare, Roanoke, Virginia (Division sold and relocated to

Florida) 2003

(The leading provider of comprehensive disease management programs to

health plans and employers with $70 million in contract revenues annually)

VICE PRESIDENT OF HEALTHCARE OPERATIONS, Diabetes Self Care - Duties

included operationalizing successful disease management programs and mail

order services for more than 200 contracts, 200,000 patients and providers.

> Turned around a struggling disease management operation through

deployment of the first ever Quality Assurance Program for the division,

consequently decreasing costs by $6.2 million within the first 3 months.

> Reduced delinquent physician orders by 120,000 and documentation backlog

of 250,000 within 30 days by streamlining technology designed to automate

all aspects of document processing, imaging and retrieval.

> Restructured management team and service center staffing levels which

proved instrumental in increasing contractual compliance with performance

metrics and standards from 78% to 95%.

American Medical Response, Aurora, Colorado (Left due to corporate downsizing)

2000 to 2002

(The world's largest medical transportation provider, with annual contract

revenues of $52 million)

VICE PRESIDENT OPERATIONS, National Products & Services - Duties included

delivering products and services to 4 regions, including 5 national and

local service center operations providing EMS Clinical Management, Event

Medical, Physician Referral and Nurse Advice Services.

> Selected by the CEO to develop and deploy a Revenue Cycle Management

strategy that localized national billing and service center operations

and technology, thereby reducing operating costs by $9.5 million and

increasing customer satisfaction by 35%.

> Transitioned obsolete IT infrastructure and processes required to provide

clinical protocol management and monitor response time criteria

increasing compliance from 40% to 80% within the first 3 months.

> Managed system development enhancements to support contractual

requirements and desired product functionality that accomplished the

following 2 items: 1) Increased productivity by 30%; and 2) Reduced

operational costs by $350,000.

[pic]

Previous to 2002 Professional Experience

WebMD, Golden, Colorado 1992 to 2000

Vice President of Client Services, South Central Region (1998-2000);

National Director, Network Quality Assurance (1996-1998); Regional

Director, Licensed Network Division (1994-1996); and Director of Physician

Practice Network Development/Administration (1992-1994)

[pic]

Education, Awards & Honors

Attended for 2 years University of Nebraska Lincoln, at Kearney, Nebraska

(Pursuing Business Administration Degree)

Biltmore Who's Who Among Executives and Professionals, Women Honor's

Edition

Member of Strategic Advisory Board for one of the Nations' Largest HMO

Relationships

Served on the Board of Directors for 2 Joint Venture Partnerships

Received 2 'Network of the Year Awards' in recognition of outstanding

performance and improving client relationships

Contact this candidate